Provider Demographics
NPI:1104250976
Name:BRALICH, LORNA FRANCES-JACQUELINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:FRANCES-JACQUELINE
Last Name:BRALICH
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-713-0947
Mailing Address - Fax:
Practice Address - Street 1:791 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1252
Practice Address - Country:US
Practice Address - Phone:336-716-4551
Practice Address - Fax:336-716-9642
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2025-05-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant